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General NPI Number Information
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NPI Number | 1134315948
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Entity Type | Organization
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Legal Business Name | ENDO-INDY, INC.
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Dates
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Enumeration Date | 09/15/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 998 E MAIN ST STE 104
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City | DANVILLE
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State | IN
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Zip | 46122-1900
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Country | US
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Telephone | 317-745-6305
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Fax | 317-298-8064
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Provider Business Mailing Address
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Address Line | 998 E MAIN ST STE 104
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City | DANVILLE
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State | IN
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Zip | 46122-1900
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Country | US
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Telephone | 317-745-6305
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Fax | 317-298-8064
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM MICHAEL MCCUNE
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Credential | M.D.
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Telephone | 317-745-6305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 01023945A
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License Number State | IN
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